Providing effective care to marginalized populations becomes easier thanks to The Hotel Study

​An ongoing study by researchers from BC Mental Health and Substance Use Services, the University of British Columbia and Simon Fraser University is helping dispel myths and improve care for people living in marginalized communities, including those who live on Vancouver’s Downtown Eastside.

The Hotel Study is an ongoing project that tracks people with both mental health and substance use challenges, or concurrent disorders. Now going into its second decade, the study follows over 400 adults living in marginalized housing and looks at mental, physical and social health factors to better understand mental health.

“To understand how these conditions will affect a person’s lifespan, their relationships, and their functionality, we need to observe them over time,” says Dr. Donna Lang, one of the principal investigators at BC Mental Health and Substance Use Services and an associate professor at the University of British Columbia.

When The Hotel Study began in 2008, Dr. Lang says that there was still a belief that the biggest health concern among participants would be substance use.

“We learned that, yes, substance use is a significant and serious concern for many of our participants but the reality is that mental illness is a component for almost 70-75 per cent of our participants,” she says. “We cannot overlook that from a public health perspective.” 

Dr. William Honer, the study’s lead researcher at BC Mental Health and Substance Use Services and a professor at the UBC Department of Psychiatry, was surprised at some of the recent results.

“We learned that, in our study, more than half the people who are living in precarious housing or who have no fixed address also had psychosis for some period of time,” he says. “The amount of people living with mental disorders was quite profound, as was its severity in some cases. Some of the people living in the Downtown Eastside appeared to have symptoms just as severe as patients with treatment-resistant psychosis that we see in the inpatient unit of the BC Psychosis Program at UBC Hospital. So that was surprising too.”

Several researchers with BC Mental Health and Substance Use Services are contributing to the study and bringing their respective expertise to understanding the complex needs of the hard-to-house population.

In addition to his research at BC Mental Health and Substance Use Services, Dr. Will Panenka is an associate professor in the Department of Psychiatry at UBC. He is studying the very high frequency of traumatic brain injury in this population, discovering that it’s about seven to eight times higher than the general population.

Dr. Allen Thornton is a neuropsychologist at Simon Fraser University, as well as a researcher with BC Mental Health and Substance Use Services. In this study, he contributes knowledge of cognitive problems and how concurrent disorders may impact such things as decision-making. Dr. Alasdair Barr is an associate professor at UBC’s Department of Anesthesiology, Pharmacology and Therapeutics, and a BC Mental Health and Substance Use Services researcher, and brings an understanding of the physiology of substance use and why many subjects continue to have such a high level of tolerance. A number of graduate and undergraduate students, research assistants, and student volunteers at BC Mental Health and Substance Use Services are also involved.

The study, funded by organizations including the Canadian Institutes of Health Research, is lengthy and complex, but has led to a rich cache of data. Dr. Honer and the research team have published over 25 peer-reviewed articles to date, a remarkable number to come out of one study.

“There is no other study in the world that I know of on this population that has been as comprehensive or as in-depth as this one,” says Dr. Lang. “Even though we still don’t understand the interactions between homelessness, mental illness and substance use, our understanding here in Vancouver, BC is unparalleled to anywhere in the world. There’s nothing else that comes close to it.”

Dr. Lang acknowledges the perception of many that, despite the outpouring of resources in the Downtown Eastside, not much has changed in the neighbourhood.

“By collecting all this data, we can see what is happening among this population,” she says. “They’re coming out of circumstances where they’ve had significant PTSD, but they’re not actually receiving sufficient treatment for their mental illnesses."

“Many also have what I call invisible physical injuries. They’ve had multiple head injuries, and their brain structure and function are not good. And, in general, their physical health is poor. Most don’t necessarily die of an overdose. They’re often dying of untreated infections, cancer and heart disease.”

Dr. Jehannine Austin, the executive director of BC Mental Health and Substance Use Services Research Institute and a professor of psychiatry and medical genetics at UBC, hopes that the study will lead to more integrated, specialized services for this vulnerable population—a group which has, in the past, been left out of research studies as a result of difficulties reaching them, especially over long periods of time.

“These people are all unique individuals,” she says. “Each has their own set of complex needs that need to be looked at in detail. They might have HIV, hepatitis C, opioid-use disorder, psychosis – where they lose touch with reality, maybe a serious head injury. They need specialized medical support and personalized services. At BC Mental Health and Substance Use Services, we provide care to a concurrent disorders population and our work is informed by some of the most esteemed researchers in the world when it comes to this group. Studies like this one that focus specifically on these populations are critical in giving us insight into their unique health needs.”